| NPI | 1114062999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002824) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11978T) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2023-03-07 |